Asthma and COPD (chronic obstructive pulmonary disease) are the two most common long-term lung conditions we treat in internal medicine. Both narrow the airways and make it hard to move air, both cause shortness of breath, wheezing and cough, and both can make everyday life feel stressful and limited. They are different diseases, though, with different causes, different patterns and somewhat different treatment, and some people have features of both.
Neither condition can be cured, but both can be controlled. With the right diagnosis, the right inhalers used the right way, and a plan for flare-ups, most people with asthma can live with few or no symptoms, and people with COPD can breathe more easily, stay more active and have fewer serious flare-ups.
The difference between asthma and COPD
Asthma is a long-term inflammation of the airways that makes them overly sensitive. When exposed to a trigger, the airways swell, the muscles around them tighten and extra mucus forms. The National Heart, Lung, and Blood Institute lists triggers such as pollen, exercise, viral infections and cold air; dust mites, pets, mold, smoke and strong odors are common as well. Asthma often starts in childhood but can begin at any age. Symptoms tend to come and go, sometimes as sudden attacks, and between episodes breathing can be normal. Many people with asthma also have allergies.
COPD is lasting damage to the airways and air sacs, usually in the form of emphysema, chronic bronchitis, or both. According to the NHLBI, most people with COPD smoke or used to smoke; long-term exposure to dust, fumes and air pollution also contributes. COPD typically appears after age 40, and the symptoms are more constant: breathlessness with activity that slowly worsens, a daily cough, and phlegm. Flare-ups, often set off by colds or flu, can make it suddenly worse.
Both conditions can cause shortness of breath, wheezing, chest tightness and cough. Because heart disease can cause similar symptoms, part of our job is to confirm that the lungs really are the source.
How we evaluate asthma and COPD at NYMD Center
We start with a detailed history of your symptoms, their pattern and triggers, your smoking and exposure history, allergies, and past treatment, followed by an exam of your lungs, heart and nose. Pulse oximetry checks your oxygen level. An ECG, chest X-ray or blood work may be added to look for heart problems, infection or other causes of breathlessness.
The key test for both conditions is spirometry, a breathing test that, as the NHLBI describes, measures how much air you breathe out and how fast. It is repeated after you inhale a fast-acting bronchodilator to see how much your airflow improves. Airflow that improves a lot points toward asthma; airflow that stays reduced points toward COPD. We refer you for spirometry at a pulmonary function lab and use the results both to diagnose you and to track how well treatment is working over time.
Treatment options, least invasive first
Trigger control and stopping smoking
For asthma, identifying and reducing your triggers, such as allergens, smoke and irritants, lowers how often attacks happen. For COPD, stopping smoking is the most important step, because it slows further lung damage. We help with counseling and medications that make quitting more achievable. These steps cost nothing in side effects, though they take persistence.
Rescue inhaler
A fast-acting bronchodilator opens the airways within minutes and is used for sudden symptoms or before exercise. Needing it more than occasionally is a sign that your condition is not well controlled and that a daily controller may be needed.
Controller inhalers
For persistent asthma, an inhaled corticosteroid, often combined with a long-acting bronchodilator, reduces airway inflammation and prevents attacks. For COPD, long-acting bronchodilators, either a LAMA or a LABA or both, are the mainstay, with an inhaled steroid added for some patients with frequent flare-ups. Side effects are usually mild, such as hoarseness or thrush from inhaled steroids, which rinsing your mouth helps prevent.
Inhaler technique and an action plan
Many people use their inhalers in a way that delivers much less medicine to the lungs than intended. We check your technique and adjust devices or add a spacer when needed. We also give you a written action plan that says what to take every day, what to do when symptoms worsen, and when to call us or go to the emergency room.
Vaccines
Respiratory infections are a leading trigger of flare-ups. The CDC considers a yearly flu shot especially important for people with asthma, and the injected vaccine is preferred over the nasal spray. The CDC also recommends pneumococcal vaccination for all adults 50 and older and for younger adults with certain risk conditions, and a single dose of RSV vaccine for adults 75 and older and for younger older adults at increased risk, including those with chronic lung disease. We review your record at a vaccination review and bring you up to date.
Pulmonary rehabilitation, oxygen and specialist care
For COPD that still limits you despite medication, we refer to pulmonary rehabilitation, a supervised program of exercise training, education and breathing techniques. Patients with low oxygen levels may need supplemental oxygen. Severe or hard-to-control asthma and advanced COPD are referred to pulmonology for further options, which in selected cases include procedures or surgery.
What to expect at your visit
Bring all your inhalers and other medications, and any prior breathing test results. Expect a detailed conversation, an exam and oxygen check, a review of your inhaler technique, and a plan for testing and treatment. Follow-up visits track your symptoms, how often you use your rescue inhaler, and any flare-ups, so we can step treatment up or down.
When to seek care urgently
Call 911 if an asthma attack or COPD flare is not relieved by your rescue inhaler, if you are too short of breath to speak in full sentences, if your lips or fingertips turn blue or gray, or if you become confused or very drowsy. Call us the same day if you need your rescue inhaler much more than usual, or if your cough, phlegm or breathlessness is clearly worsening.
Questions patients ask
Can you have both asthma and COPD?
Yes. Some people, particularly longtime smokers who also have asthma, have features of both, sometimes called asthma-COPD overlap. Spirometry before and after a bronchodilator, along with your history, helps sort out the pattern. Treatment then combines approaches from both conditions, often including an inhaled steroid together with long-acting bronchodilators.
How is asthma or COPD diagnosed?
The key test is spirometry, a breathing test that measures how much air you can blow out and how fast. It is repeated after you inhale a fast-acting bronchodilator. A large improvement points toward asthma, while airflow that stays reduced points toward COPD. Your history, exam and sometimes a chest X-ray or other tests complete the picture.
How often should I need my rescue inhaler?
If your asthma is well controlled, you should rarely need it apart from before exercise. Using your rescue inhaler more than occasionally, waking at night with symptoms, or needing it more than usual is a sign that your condition is not controlled and that your daily treatment should be reviewed. Call us rather than relying on the rescue inhaler alone.
Which vaccines matter if I have asthma or COPD?
A yearly flu shot is especially important, and the injected vaccine is preferred over the nasal spray for people with asthma. Pneumococcal vaccination is recommended for adults 50 and older and for younger adults with certain conditions, and RSV vaccination is recommended for older adults at higher risk, including those with chronic lung disease. We review your record and update it.
Does COPD get worse over time?
COPD tends to progress, but how fast depends heavily on whether you keep smoking and how well flare-ups are prevented. Stopping smoking slows the decline more than any medication. Long-acting inhalers, vaccines, staying active and pulmonary rehabilitation help you breathe more easily and reduce flare-ups.